Volume 128, Issue 5 p. 809-821
Systematic Review

Duration of estrogen exposure during reproductive years, age at menarche and age at menopause, and risk of cardiovascular disease events, all-cause and cardiovascular mortality: a systematic review and meta-analysis

SR Mishra

Corresponding Author

SR Mishra

School of Public Health, The University of Queensland, Brisbane, Australia

Correspondence: SR Mishra, School of Public Health, University of Queensland, 266 Herston Rd, Herston QLD 4006, Australia. Email: [email protected]

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H-F Chung

H-F Chung

School of Public Health, The University of Queensland, Brisbane, Australia

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M Waller

M Waller

School of Public Health, The University of Queensland, Brisbane, Australia

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GD Mishra

GD Mishra

School of Public Health, The University of Queensland, Brisbane, Australia

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First published: 23 September 2020
Citations: 53
PROSPERO registration: CRD42019126655

Abstract

Background

Little is known about the estrogen exposure measurement and mutual effect of age at menarche and age at menopause in the risk of cardiovascular disease (CVD) events.

Objectives

To evaluate estrogen exposure measurement and describe mutual effect of age at menarche and age at menopause in the risk of CVD events.

Search strategy

Systematic review of literature in PubMed, Embase and Web of Science for studies published up to 28 June 2020.

Selection criteria

Observational studies related to estrogen exposure measurement, including mutual effect of age at menarche and age at menopause and risk of CVD events.

Data collection and analysis

Synthesis of evidence was conducted by reviewing individual estimates, followed by meta-analysis. The study received no external funding.

Main results

A total of 75 studies were included in synthesis of evidence, of which 17 studies were included in meta-analysis. Reproductive lifespan (age at menopause – age at menarche), endogenous estrogen exposure and total estrogen exposure were used for estrogen exposure measurement. Reproductive lifespan was by far the most commonly used method for estrogen exposure measurement. A shorter reproductive lifespan was associated with a higher risk of CVD events; the pooled relative risk (95% CI) was 1.31 (1.25–1.36) for stroke events. Robust epidemiological studies with measurement of estrogen exposure and associated health risk would strengthen the evidence.

Conclusions

Reproductive lifespan was the most commonly used method for estrogen exposure measurement in epidemiological studies. A shorter reproductive lifespan was associated with a higher risk of CVD events, particularly stroke.

Tweetable abstract

A systematic review and meta-analysis found that women with a shorter reproductive lifespan have a higher risk of stroke events.